Bush cousin opposes Markey on bill

Representative Edward J. Markey, who has been touting a bill to keep thousands of data-entry jobs generated by healthcare companies from going overseas, ran into a spirited opponent between the sushi boat and the open bar at an inaugural party last month: Jonathan S. Bush, theWaltham healthcare entrepreneur and President Bush’s cousin.

Bush is the president of athenahealth Inc., which employs about 200 low-wage workers in India to enter medical data for its clients, including many doctors and hospitals in Massachusetts. Bush insists Markey’s proposal would put his company out of business, leaving 370 workers in Markey’s own district out of work.

The contretemps between the two men offered a glimpse into the increasingly heated politics of outsourcing, and whether global free trade creates US jobs or takes them away. It also could be a preview of a larger debate to come, when the president launches a planned nationwide system of medical records, creating tens of thousands of data-entry jobs, jobs that, barring the success of Markey’s bill, could easily and cheaply be filled by workers inIndia.

Markey and Jonathan Bush engaged in an impromptu debate at the reception hosted by Governor Mitt Romney at Washington’s Mandarin Oriental last month. Bush, the son of former President George H. W. Bush’s younger brother Jonathan, said Markey would drive up healthcare costs inMassachusetts; Markey countered that he is trying to protect privacy and save jobs that could go to lower-income people in Eastern Massachusetts.

“Markey’s bill would kill us,” Bush said later. “We’re providing a very valuable service, and we’re netting a huge number of jobs. This is crazy.”

Markey, a Malden Democrat who is cochairman of the Congressional Privacy Caucus, is seeking to outlaw the transmission of any health or financial information about US citizens to people in other nations: The bill would prohibit outsourcing of jobs in financial services and insurance as well as in healthcare.

The congressman justifies outlawing the outsourcing of medical-data jobs on the grounds that other countries do not have nearly as extensive privacy laws as the United States. His bill, which he filed last year and intends to reintroduce in Congress this year, aims to protect consumers’ privacy and American jobs in a single measure, according to the congressman.

“It’s becoming increasingly clear that both our jobs and our privacy are being shipped offshore, and federal regulators aren’t doing nearly enough to stop it,” Markey declared. “If their business is in Boston, the bill doesn’t affect them. If the business is inBombay, then they need to get the individuals’ permission.”

The measure was bottled up by the Republican-controlled Congress last year. But it is part of a package of measures supported by the Democratic leadership to slow the offshoring of jobs, and Markey said consumer privacy and offshoring are bipartisan issues in an era of identity theft and the loss of US jobs to distant countries.

Though athenahealth has not had any problems with personal records leaking into the public domain, incidents involving other companies have drawn alarm. In 2003, a Pakistani woman who entered data for the University of California-San Francisco Medical Center threatened to display patients’ medical records publicly unless she was paid more money.

Jonathan Bush argues that the bill is not needed, because US-based companies are covered by health privacy laws regardless of where they hire workers.

“If that data, while under our control, was in any way compromised, we’re dead meat if something goes wrong with that information,” said Bush, who cofounded athenahealth in 1997.

Bush said Markey’s bill could actually harm patients’ privacy, because money now being spent on protecting privacy would instead have to be spent to pay higher wages to American data-entry workers: “Because we have [the low-wage workers], we can afford to do a very sophisticated and elaborate blinding system to separate identity from the information.”

Athenahealth hires about 200 workers in India to enter medical records, lab results, and billing and insurance claims into computers. Bush said those workers cost between $6 and $8 an hour to hire — including overhead associated with their work stations and managers — and estimated that similar work would cost twice as much in the United States. He said he did not know how much the individual workers make because the work is contracted through another firm in India.

He said athenahealth’s partners in India also give the company the flexibility to hire additional workers whenever they are necessary, something that would be more difficult to achieve in the United States, which has costly bureaucratic requirements whenever a new employee joins a company. Plus, many of the Indian workers hold advanced degrees, making them far more qualified for the job than the pool of talent that would be available in America, Bush said.

Markey concedes that healthcare providers could face steeper costs under his measure, but he insists that electronic data are still cheaper to process than paper records, and that cost should not be a factor when it comes to protecting personal privacy.

“We don’t have federal marshals in Bombay,” he said. “These records are the most sacred information a family has, and Americans don’t view privacy as a commodity. It’s not a razor blade. It’s not an automobile. It’s a value. It’s the identity of their family.”

US companies are covered by federal privacy-protection provisions, but the problem comes in enforcement, said Jonathan Bogen, president of HealthCIO, a consulting company on health privacy issues. Workers in India may not be properly trained, and the federal government has no way to check up on how private data is being handled by overseas workers, Bogen said.

Bush said the jobs he is creating in India are contributing to a boom in that country, with new schools and medical facilities being constructed with the wages he is paying. He sees his company as taking advantage of the best that globalization has to offer — lifting up a developing country with jobs that would be difficult to fill in the United States, and forging a new path in the US with an industry that didn’t exist a few years ago.

“This is the best thing that could ever happen to the Commonwealth,” Bush said.

But Markey said the data-entry jobs should be back inMassachusetts — and with medical privacy involved, the importance of bringing the jobs under USoversight is heightened.